Physiotherapy for Runners Knee

Patellofemoral pain is often commonly referred to as “Runners Knee” or anterior knee pain. This condition is a non-specific term referring to pain around the front of the knee in the kneecap (patella) area.

Runners, or people who play sports that involve running and/or jumping, will often develop this condition when starting training for the first time or when returning to exercise after a period of rest. This happens because when we have a break from training all the muscles, tendons, soft tissue and bony structures decondition, become weaker and are less able to tolerate loading. As a result, when we get back into running the patellofemoral joint can be loaded more than usual leading to irritation and inflammation of the area.

Another cause of patellofemoral pain can be related to running biomechanics. Runners who have a cross-over running gait where one or both of their legs crosses the midline of their body are more at risk of developing this condition. This is because when our legs cross the midline of our body we put greater tension on the outside (lateral) structures of our knee. Through repetition of the running gait cycle this repeated tension can cause a small lateral pull on the kneecap, causing it to sit in a slightly different position to normal. When this happens the point of friction is changed, overloading certain areas on the under-surface of the kneecap and leading to inflammation and pain.

Treatment for runners knee includes a combination of modifying load and correcting any underlying biomechanical factors or strength deficiencies. If you are a runner your running load should be modified so that you can complete your entire session without the pain going over a 2/10 pain score. This can be done by reducing the total amount of running in the session or avoiding hills which can increase stress in the patellofemoral joint. The pain should also settle within a few hours of completing the run and be no worse the next morning. If you can fulfil all these criteria then you can be confident that you can continue running without worsening the condition. The same principles apply to other sport and exercise sessions.

Correcting any biomechanical issues related to your running gait can also help to reduce the pain associated with runners knee. As mentioned earlier when a runner’s foot crosses over the midline of their body the risk of this injury occurring increases. Simply cueing yourself to not let your legs cross over each other, or even simpler not allowing your knees to touch when running, can help to reduce pain. If you are unsure whether you are doing this correctly it can be very useful to have a running gait assessment to have your technique analysed.

Correcting strength deficits can also help in the management of runners knee. When there are significant weaknesses in the gluteal muscles that produce hip abduction it can lead to an increase in hip adduction on landing. This means the leg collapses inwards, potentially contributing to a cross-over running gait and putting more strain through the lateral structures of the thigh. Weaknesses in quadiceps and hamstring muscles can also increase stress through the patellofemoral joint so strengthening these muscles will also be helpful.

Your physiotherapist may also tape your kneecap to reduce your pain. This will often allow you to maintain a higher level of running and strength exercise while we resolve your injury. The tape is used to hold your kneecap in the right alignment while we restore the correct balance of muscle length and strength, and work on improving your running biomechanics.

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